Abstract: :
Purpose:Scleral sutured tantalum markers are used for tumorlocalization in proton beam radiotherapy (PBRT) of uveal melanomas.This study examines how varying the number of markers placedaffects treatment outcomes.Methods:Seventy-four patients withuveal melanoma were treated with PBRT between April 1995 andAugust 2001. Tantalum marker placement was varied in a non-randomizedfashion with patients receiving a minimum of 3 and a maximumof 7 markers per eye. Tumor size was designated as small, medium,large, or extra-large. Patients received between 48 and 56 Gy.Median age was 61.2 years. Median follow-up was 18.2 months.Results:Thirty patients received 3 markers, 22 patients received4 markers, and 22 patients received 5 or more markers. Neovascularglaucoma (NVG) rates were similar in all groups, ranging from9.5% to 14%. Cataract formation was similar in all groups, 16%to 20%. Enucleation was performed in 17% of patients with 3markers, 9.5% with 4 markers, and 24% with 5 or more markers.Dry eye symptoms were less frequent in patients with 3 markers,10%, compared to 4 or more markers, 31%. Lash loss, 27%, andradiation retinopathy, 13%, were more frequent in patients with3 markers compared to those with 4 or more markers, 9.3% (lashloss) and 7% (retinopathy). The subset of small and medium sizedtumors was compared further. None of these patients had NVGor underwent enucleation. In this subset, patients with 3 markersexperienced lash loss of 29% and radiation retinopathy of 19%,compared to those with 4 or more markers, 4.7% (lash loss) and4.5% (retinopathy). Dry eye symptoms were seen in 10-26% ofthose with 3 or 4 markers and none of those with five or moremarkers.Conclusion:In patients with small and medium sizedtumors, increased marker number correlated with a decrease incomplications such as lash loss, retinopathy, and dry eye symptoms.Complications such as NVG and enucleation were limited to patientswith large or extra-large tumors. Cataract formation was similarin all groups and may be related to the median age of the patientpopulation.